Published in JAMA Network Open, the research revisits evidence from nine randomized controlled trials involving 1,258 adults with recurrent depression. The participants were generally in partial or full remission when they entered the original studies, meaning they were not experiencing the most severe phase of an acute depressive episode. The researchers used individual participant data rather than relying only on summary results reported in earlier publications. This approach allowed them to examine changes in symptoms for each participant and compare the likelihood of worsening between people assigned to MBCT and those receiving control treatments.

MBCT combines techniques from cognitive behavioral therapy with structured mindfulness practices. Cognitive behavioral therapy helps patients identify patterns of thinking that can intensify emotional distress and teaches strategies for responding to those patterns differently. Mindfulness training, meanwhile, encourages people to observe thoughts, feelings and bodily sensations without immediately judging or reacting to them. In clinical programs, participants typically practice meditation and mindful movement while learning how to recognize early warning signs of relapse. The aim is not to eliminate difficult thoughts, but to reduce the automatic cycles of rumination and avoidance that can contribute to depression.

The treatment became a major focus of depression research after a landmark 2016 meta-analysis combined results from nine studies and supported MBCT as an effective strategy for preventing relapse. A meta-analysis statistically integrates findings from multiple investigations, increasing the amount of evidence available and making it possible to estimate an overall treatment effect. Those earlier findings helped establish MBCT as a recommended option for people with recurrent depression. But the treatment’s growing popularity also prompted a difficult safety question: could intensive attention to distressing thoughts and emotions make some patients feel worse?

That concern was fueled by limited studies in which patients reported harmful or troubling experiences during mindfulness-based interventions. Such reports deserve attention, particularly when an intervention is delivered across healthcare systems and to large populations. However, the earlier studies generally lacked a control group. Without a comparison group, researchers cannot determine whether symptom worsening was caused by the treatment, by the natural course of depression, by unrelated life events or by the difficulties faced by people receiving other forms of care. Depression symptoms can fluctuate even when no intervention is introduced, making controlled comparisons essential for assessing risk.

The new analysis was designed to address that limitation. The researchers reevaluated the original trial data and defined symptom worsening by examining whether participants showed increased depressive symptoms after treatment relative to their starting point and assigned control condition. They then calculated the odds of worsening in the MBCT groups compared with participants who received alternative interventions or control care. Some control groups included people taking antidepressant medication, allowing the investigators to make additional comparisons with a commonly used medical treatment. Because the analysis used data from randomized trials, assignment to MBCT or control conditions was not determined by patients’ preferences or clinicians’ expectations alone, reducing several sources of bias.

The central result was clear: the data provided no evidence that MBCT increased the odds of depressive symptom worsening compared with control conditions. In some secondary analyses, participants assigned to MBCT appeared to have a lower risk of worsening than those receiving other treatments, including antidepressants. These additional findings should be interpreted cautiously because secondary analyses can be affected by differences among the original trials, treatment formats and comparison groups. Nevertheless, the overall pattern did not support the idea that MBCT carries a general risk of worsening depression for the average patient participating in relapse-prevention treatment.

The findings do not mean that every person will benefit from mindfulness practice or that unwanted experiences are impossible. Psychological treatments can affect patients differently, and some people may find meditation uncomfortable, emotionally demanding or difficult to practice without expert guidance. The trials included in this analysis also focused mainly on adults who had recurrent depression but were in partial or full remission. Their results may therefore not apply directly to people experiencing acute, severe depression, individuals with other psychiatric conditions or patients whose symptoms are changing rapidly. Clinicians still need to monitor patients carefully, discuss possible reactions to treatment and provide alternative care when necessary.

Researchers say the next generation of randomized trials should collect a broader range of information about patient experiences, including both benefits and harms. Standard measures of depressive symptoms are important, but they may not capture feelings such as emotional disconnection, heightened anxiety, distress during meditation or changes in day-to-day functioning. More detailed safety monitoring could help identify whether particular patients, practices or delivery settings are associated with different outcomes. It could also distinguish temporary discomfort that resolves with support from clinically meaningful deterioration requiring a change in treatment.

For now, the study strengthens the evidence supporting MBCT as a relapse-prevention option for recurrent depression. Its importance lies not in showing that mindfulness is universally effective, but in testing a specific safety concern with controlled data from more than a thousand participants. As MBCT continues to spread through hospitals, mental health services and community programs, the analysis offers a measured message: available trial evidence does not show that the therapy makes depressive symptoms worse relative to control care, while future research should continue to examine who benefits most, who may struggle and how psychological treatments can be delivered as safely as possible.

Subject of Research: People

Article Title: Symptom Worsening in Mindfulness-Based Cognitive Therapy

News Publication Date: 20-Aug-2026

Web References: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2026.29946 ; https://doi.org/10.1001/jamanetworkopen.2026.29946

References: JAMA Network Open; 2016 meta-analysis indexed at https://pubmed.ncbi.nlm.nih.gov/27119968/; World Health Organization depression fact sheet at https://www.who.int/news-room/fact-sheets/detail/depression

Keywords: Mindfulness-based cognitive therapy, depression, relapse prevention, mental health, meta-analysis, symptom worsening, psychotherapy

The question matters because clinical trials commonly report mean changes in symptom scores. An average reduction in depression can suggest that a therapy is beneficial overall, yet averages may conceal a smaller group of participants whose symptoms remain unchanged or become worse. By analyzing individual participant data, researchers can examine the distribution of outcomes more closely, compare the number of people who deteriorate across treatment groups, and investigate whether particular baseline characteristics are linked to worsening symptoms. This approach can provide a more clinically relevant assessment of both benefit and risk.

Mindfulness-based cognitive therapy, often abbreviated MBCT, combines mindfulness practices with techniques derived from cognitive behavioral therapy. Participants are typically taught to observe thoughts, emotions and bodily sensations without immediately reacting to them, while also learning to recognize patterns of negative thinking that can contribute to depressive relapse. The treatment was developed in part for people with a history of recurrent depression and is commonly delivered through structured group sessions, guided exercises and home practice. Rather than attempting to eliminate distressing thoughts, MBCT aims to change how individuals relate to them.

The therapy’s potential relationship with worsening depression is scientifically complex. Mindfulness exercises can increase awareness of internal experiences, including sadness, anxiety, intrusive memories or self-critical thoughts. For many people, this awareness may support emotional regulation and reduce automatic patterns of rumination. For others, particularly those with severe symptoms or limited support, focusing attention inward could initially feel destabilizing or intensify distress. A careful analysis must therefore distinguish temporary discomfort from clinically meaningful deterioration and determine whether worsening occurs more frequently than would be expected in an appropriate comparison group.

Randomized clinical trials provide the strongest framework for evaluating that question because participants are assigned to treatment or control conditions rather than choosing between them. Randomization helps balance known and unknown factors that could influence outcomes, such as illness severity, previous treatment, age or coexisting psychiatric conditions. The new analysis pools data from these trials at the level of individual participants. Unlike a conventional meta-analysis, which generally combines summary statistics reported by each study, an individual participant data meta-analysis can apply consistent definitions and statistical models across trials and can explore differences among participants and treatment settings.

A key challenge is defining what counts as worsening depression. Researchers may use changes in validated symptom scales, thresholds for clinically significant deterioration, loss of remission or the emergence of severe symptoms. Different definitions can produce different estimates of risk. A technically rigorous analysis must account for baseline scores, the timing of assessments, missing data and differences in the instruments used by the original trials. It must also consider whether participants who discontinue treatment are more likely to have experienced difficulty, since excluding them could make an intervention appear safer than it is.

The analysis is particularly relevant to the way psychological treatments are communicated to patients. A therapy can have a favorable average effect while still carrying a possibility of harm for a subset of participants. Reporting only mean symptom reductions may leave clinicians without enough information to explain that uncertainty during informed consent. Conversely, identifying any worsening episode as evidence of treatment-related harm could overstate risk if symptoms fluctuate naturally or if deterioration occurs at similar rates in comparison groups. The distinction between association and causation is therefore essential: an increase in symptoms during MBCT does not automatically demonstrate that mindfulness caused the increase.

The work by Simon B. Goldberg of the University of Wisconsin-Madison and Willem Kuyken of the University of Oxford addresses this issue through a collaboration spanning clinical psychology, psychiatry and quantitative research. By combining randomized evidence, the investigators can examine whether deterioration is more common among people receiving MBCT than among participants assigned to control conditions. They may also be able to assess whether the pattern varies according to treatment format, participant history or the level of depressive symptoms at enrollment. Such subgroup analyses are informative but must be interpreted cautiously, because dividing participants into many categories can produce apparently important findings that are statistically unstable.

The study’s focus on adverse outcomes reflects a broader shift in mental-health research toward balanced evaluation. Psychological interventions are often described primarily in terms of effectiveness, while harms, nonresponse and treatment dropout receive less attention. A comprehensive assessment should measure all three: who improves, who does not improve and who becomes worse. This is especially important for depression, a condition in which symptoms can change over time and in which clinical deterioration may carry serious consequences. More precise evidence could help practitioners identify patients who need closer monitoring or additional support while participating in MBCT.

The meta-analysis does not imply that mindfulness-based cognitive therapy is broadly dangerous, nor does the research question alone establish that it causes worsening depression. Its purpose is to test the possibility with data from randomized trials and to clarify how often deterioration occurs relative to control conditions. The results will be most useful if they present both the potential benefits and the full range of outcomes, including uncertainty around risk estimates. For patients and clinicians, the practical message is that mindfulness-based treatment should be offered with appropriate screening, realistic expectations and ongoing attention to symptom changes rather than treated as universally suitable or universally risk-free.

Subject of Research: Individual participant data meta-analysis of mindfulness-based cognitive therapy and worsening depressive symptoms.

Web References: https://doi.org/10.1001/jamanetworkopen.2026.29946

References: Goldberg SB, Kuyken W, and colleagues. Study published in JAMA Network Open; full article details and author list were not provided in the supplied material.

Keywords: Mindfulness-based cognitive therapy, MBCT, depression, depressive symptoms, worsening symptoms, individual participant data, meta-analysis, randomized clinical trials, psychotherapy, mental health, treatment safety, clinical psychology.